CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 2, May/June 2023 110 AFRICA with the principles set forth in the Declaration of Helsinki. Written informed consent was obtained from the patients. The study population comprised elite male football players whose mandatory cardiological examinations were performed in the Samsun Education and Training Hospital’s Cardiology Department out-patient clinic between February and June 2022 as a part of preparticipation screening for the national football league. The football players were members of several teams included in the Samsun Amateur League. The players’ mean duration of competitive football experience was more than two years. The training programme for the football players featured training sessions lasting two to three hours, six days a week. Participants not aged 18 to 35 years, with congestive heart failure, coronary artery bypass grafting surgery, active infectious and contagious diseases, chronic inflammatory and immunological diseases, cirrhosis, peripheral artery disease, chronic obstructive pulmonary disease, chronic renal failure, malignancy, atrial and ventricular arrhythmias, a known cardiac disease or any other significant morbidity were excluded from the study. In the end, the study group consisted of 49 elite male football players (group F). The control group comprised 50 non-athlete healthy males of matching age from among the sedentary team supporters or volunteers, with less than three hours of training per week during the same period (group C). Both the study and control groups underwent the same electrocardiographic and echocardiographic cardiac examinations. Body morphometrics were documented to obtain the participants’ body mass index (BMI) and body surface area (BSA). Participants’ weight in kilograms was divided by the height squared to obtain their BMI values (kg/m2). The Dubois and Dubois formula was used to calculate BSA.18 Systolic and diastolic blood pressure measurements were performed in the out-patient clinic after at least 10 minutes of rest. All participants underwent a 12-lead electrocardiograph (Nihon Kohden Corporation, Cardiofax M Model ECG-1250, Tokyo, Japan). The images were transferred to a computer for offline analysis. The morphology and duration of P wave and PR intervals were evaluated under ×400 magnification by an experienced cardiologist, Sefa Gül. The American Society of Echocardiography guidelines were followed in the echocardiographic measurements.19 A commercially available echocardiography device (GE Vivid S5 Dimension, GE Vingmed Ultrasound AS, Norten, Norway) with a 2.5-MHz transducer was used to perform two-dimensional (2D), M-mode and tissue Doppler studies. Both systolic and ventricular diastolic parameters were measuredaccordingtotheAmericanSocietyof Echocardiography guidelines while the participant held his breath.2,3 Standard measurements of cardiac dimensions, contractility and diastolic function were performed. The wall thicknesses of the cardiac chambers and intracavitary diastolic and systolic diameters were measured. Additionally, the thickness of the systolic and diastolic interventricular septum, the posterior wall, and the diameters of the LV, aortic root and LA was measured. The left ventricular mass index (g/m2) and ejection fraction were calculated as previously.2 The mechanical function of the LV and LA, the volume and expansion indexes, and the fractionation and index of active and passive emptying were measured via tissue Doppler echocardiography. Cardiac screening was performed via conventional 2D and tissue Doppler echocardiography by the same experienced cardiologist. Statistical analysis The study’s primary outcome was determined as the volumetric and functional assessment of the LA. Descriptive statistics are expressed as mean ± standard deviation in the case of normally distributed continuous variables, as median with minimum– maximum values in the case of non-normally distributed continuous variables, and as numbers and percentages in the case of categorical variables. The Shapiro–Wilk, Kolmogorov– Smirnov and Anderson–Darling tests were used to analyse the normal distribution of the numerical variables. The Independent Samples t-test and the Mann–Whitney U-test were used to compare two independent groups in the case of normally and non-normally distributed numerical variables, respectively. Pearson’s chi-squared and Fisher’s exact tests were used to compare the differences between categorical variables in 2×2 tables. Jamovi project (Jamovi, version 2.2.5, 2022, retrieved from https://www.jamovi.org) and JASP (Jeffreys’ Amazing Statistics Program, version 0.16.1, 2022, retrieved from https://jasp-stats. org) software packages were used in the statistical analysis. Probability (p) values of ≤ 0.5 were deemed to indicate statistical significance. Results The demographic and morphometric characteristics of the study and control groups are given in Table 1. There was no significant difference between the groups in terms of age and body morphometric characteristics (p > 0.05), except for heart rate, which was significantly higher in group F than in group C (p = 0.036). There was also no significant difference between the groups in systolic and diastolic blood pressure measurements (p = 0.872 and p = 0.690, respectively). On the other hand, the groups differed significantly in electrocardiographic parameters (Table 2). Accordingly, the maximum and minimum duration of the P waves were significantly higher in group F than in group C (p = 0.011 and Table 1. Demographic and morphometric characteristics and vital signs of the study groups Variables Group F (n = 49) Group C (n = 50) p-value Age (years), mean ± SD 23.2 ± 2.3 22.8 ± 1.8 0.332* Height (cm), mean ± SD 179.7 ± 6.0 178.7 ± 6.3 0.428* Weight (kg), median (min–max) 73.0 (58.0–100.0) 74.0 (58.0–122.0) 0.628** BMI (kg/m2), median (min–max) 22.4 (20.2–28.6) 22.9 (20.1–32.4) 0.106** BSA (m2), mean ± SD 1.9 ± 0.1 1.9 ± 0.2 0.594* Heart rate (beat/min), mean ± SD 75.0 ± 6.7 71.1 ± 10.9 0.036* SBP (mmHg), median (min–max) 115.0 (105.0–125.0) 115.0 (105.0–170.0) 0.872** DBP (mmHg), median (min–max) 75.0 (70.0–90.0) 75.0 (65.0–90.0) 0.690** BMI: body mass index, BSA: body surface area, SD: standard deviation, SBP: systolic blood pressure, DBP: diastolic blood pressure. *Independent samples t-test, **Mann–Whitney U-test.
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